Aggravation of Thyrotoxicosis in Early Pregnancy and after Delivery in Graves' Disease*

Amino, Nobuyuki; Takahashi, Osamu; Mori, Hidemitsu; Iwatani, Yoshinori; Yamada, Takako; Kurachi, Keiichi; Kumahara, Yuichi; Miyai, Kiyoshi

doi:10.1210/jcem-55-1-108

Cited by 201 publications

(82 citation statements)

References 20 publications

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“…In the months following delivery, exacerbation of immune reactivity occurs between 3 and 12 months post partum (50). Therefore, autoimmune thyroid disorders may begin to recur or exacerbate during this crucial period.…”

Section: What Is the Appropriate Management Of Neonatal Thyrotoxicosis?mentioning

confidence: 99%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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Introduction: Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo-or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods. Aim: To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation. Methods: A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.' Results: Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation. Conclusion: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.

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Section: What Is the Appropriate Management Of Neonatal Thyrotoxicosis?mentioning

confidence: 99%

Management of hyperthyroidism during pregnancy and lactation

Azizi

Amouzegar²

2011

European Journal of Endocrinology

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“…Relapse of the hyperthyroidism may occur during pregnancy, but this is not common. More frequently, recurrence of the hyperthyroidism may occur during the post partum period (4,5).…”

Section: Graves' Disease and Pregnancy In Various Combinationsmentioning

confidence: 99%

“…My doctor prescribed PTU three times 100 mg daily and T 4 . During my pregnancy the treatment remained the same.…”

Section: Risks and Complications From Graves' Hyperthyroidism And Thementioning

confidence: 99%

“…Maternal TRAb was high at 99 U/l (reference !10 U/l, TRAK assay, BRAHMS), and the thyroid stimulating activity was high (1396% of reference in a bioassay (43)). The dose of PTU was temporarily increased to 300 mg/day and subsequently fluctuated between 150 and 250 mg/day according to fT 4 and fT 3 levels. Sonographic evaluations of the foetus had been normal, but at week 33 of gestation an enlarged foetal thyroid measuring 40!17 mm (maximal length!…”

Section: Casementioning

confidence: 99%

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Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

Laurberg¹,

Bournaud²,

Karmisholt³

et al. 2009

European Journal of Endocrinology

161

102

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Graves' disease is a common autoimmune disorder in women in fertile ages. The hyperthyroidism is caused by generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves' hyperthyroidism but also in her foetus. The review includes two cases illustrating some of the problems in managing Graves' disease in pregnancy.Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (L-T 4 ) given to the mother will have only a limited effect in the foetus.Surgical thyroidectomy of patients with Graves' hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomyCwithdrawal of antithyroid medicationCL-T 4 replacement of the mother involves a high risk of foetal hyperthyroidism. Conclusion: Antithyroid drug therapy of pregnant women with Graves' hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal hyperthyroidism.

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“…Therefore, the 99m Tc-pertechnetate or 123 I thyroid uptake test could not be performed. It is well known that postpartum silent thyroiditis may develop in patients with Graves' disease in whom treatment with antithyroid drugs (methimazole and propylthiouracil) was discontinued before the pregnancy or during pregnancy (14)(15)(16). In the present patient, hypothyroidism followed thyrotoxicosis after the delivery.…”

Section: Discussionmentioning

confidence: 63%

Thyroid Hemiagenesis with Postpartum Silent Thyroiditis

2004

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A 28-year-old woman with thyroid hemiagenesis, who had been diagnosed as having Graves' disease, became pregnant during the course of methimazole treatment. The treatment was terminated in the second trimester. She delivered a normal infant at full term. She became thyrotoxic 3 months after the delivery, hypothyroid 6 months after the delivery, and finally euthyroid 11 months after the delivery without undergoing any treatment. This clinical course indicates that she developed silent thyroiditis after the delivery. A diagnosis of thyroid hemiagenesis was made on the basis of ultrasonography of the thyroid and 99m Tc-pertechnetate thyroid scintiscan.

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Aggravation of Thyrotoxicosis in Early Pregnancy and after Delivery in Graves' Disease*

Cited by 201 publications

References 20 publications

Management of hyperthyroidism during pregnancy and lactation

Management of hyperthyroidism during pregnancy and lactation

Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy

Thyroid Hemiagenesis with Postpartum Silent Thyroiditis

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